February 2009

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Do doctors who use physician-only social networking sites expose themselves to malpractice risk?

in Physician | 4 responses

One of the newer trends is doctors using social networking sites like Sermo and iMedExchange.

Likened to a "virtual doctor's lounge," physicians can ask questions and speak freely knowing their posts will not be seen by, or released to, the public.

Often times, questions about patient management are asked, and it's nice to have a quick response to queries by a variety of specialists.

In this ...

How following hospital quality measures can kill patients

in Physician | 8 responses

Here's what happens when you give so much attention and influence to such a crude instrument.

Following quality measures can make or break a hospital's reputation, especially if they are being widely advertised. Patients often make health care choices based on whether doctors following quality measures.

However, as these measures are currently constructed, they often ignore the nuance surrounding many cases.

Emergency physician WhiteCoat ...

Singing big band tunes to wake a patient out of delirium

in Potpourri | no responses

Delirium, a transient change in mental status often occurring in hospitalized patients, can be frustrating to the medical staff. Especially if they're unfamiliar with their baseline state of function.

Here's a pretty funny story that hospitalist Theresa Chan recounts, where she, along with the nurse and physical therapist, sings big band tunes to a 90-year old who recently underwent hip surgery.

Find out how the previously

Should hotels be required to have AEDs?

in Patient | 4 responses

If your heart goes into ventricular fibrillation in a hotel, shouldn't an automatic external defibrillator (AED) be on hand within minutes?

Surprisingly, that isn't the case in the majority of hotels. A recent story in the WSJ points to the fact that no more than 20 percent of hotels have such devices.

The reason? Liability, and the questions surrounding Good Samaritan laws, which some lawyers ...

Having a stroke, and taking clot-busting drugs at home

in Conditions | 5 responses

How bad did this doctor want to avoid the emergency room?

Freakonomics' blogger Steven Levitt recounts a story told by his physician-grandfather.

The 80-something year old started having symptoms consistent with a stroke. Instead of calling 911, or finding a way to an emergency room, he "called in a prescription to the drugstore around the corner for some clot-busting drugs and sent my grandmother to the ...

What happens if the safety net clinics start refusing to see Medicare or Medicaid patients?

in Policy | 5 responses

Patients on Medicare and Medicaid tend to utilize the health care system more frequently.

Combined with the fact that an increasing number of physicians are closing their doors to such patients, the so-called "safety net" clinics and hospitals are finding themselves with much more work than they can handle.

In this case in California, one such clinic was seriously considering shutting its doors to Medicare. ...

Are whites more likely to be screened for colon cancer?

in Conditions | 3 responses

According to a recent study looking at the Medicare population, the answer appears to be yes.

MedPage Today reports a study showing that elderly white patients had colon cancer screening rates ranging from 39 to 47 percent, compared to 29 to 38 percent in blacks and 23 to 33 percent in Hispanics.

First off, all those rates are dismally low. There should be no reason that ...

Op-ed: Pads, pens, prescriptions

in Meds | no responses

The following op-ed was published on February 26, 2009 in the USA Today.Have you ever noticed the pens, coffee mugs and prescription pads at your doctor's office? Chances are, they were prominently adorned with the brand name of the prescription drug its company is touting.The pharmaceutical industry has been giving these types of small gifts to doctors for years, in hopes of raising physician awareness of ...

Op-ed: More coverage requires more doctors

in Policy | 4 responses

The following op-ed was published on February 25th, 2009 in The New York Times' Room for Debate blog.With the number of the uninsured having risen to 48 million Americans, clearly the need for reform is dire. But President Obama made no mention of who exactly will take care of these patients, even if they get insurance under a successful health reform initiative.As a primary care physician in southern New ...

Patient burns from a hospital visit, and fires in the operating room

in Patient | 2 responses

When undergoing a procedure in the hospital, the last thing most patients suspect would be sustaining burns from medical equipment or carelessness of the medical staff.

Thankfully, such instances are rare, but they do occur. As the WSJ reports, the oxygen-rich environment of an operating room can increase the risk of flames, from say, a stray spark of an electrocautery device.

Furthermore, medication patches, like nicotine ...

Cheap Viagra can kill, or, the dangers of counterfeit erectile dysfunction drugs

in Meds | 2 responses

When looking for a prescription of Viagra, Cialis, or Levitra, make sure you get the real thing.

Amy Tuteur points to a recent NEJM article detailing cases in Singapore where hospitalized men were found to have taken imitation erectile dysfunction medications containing contaminents like the glucose-lowering medication glyburide, as well as host of herbal substances.

Glyburide, in particular, can be deadly in those who do not have ...

What role should nurse practitioners play in primary care?

in Physician | 11 responses

One proposed way to control costs is to replace primary care doctors with mid-level providers, like nurse practitioners and physician assistants.

Merely bringing up this idea brings out the worst in turf battles, with most discussions devolving into nurse versus doctor cat-fights.

The ACP comes up with their vision of how nurse practitioners fit within the primary care spectrum. It wisely takes a balanced approach, but, ...

Child mauled by a pit bull, but the ER sends the kid home

in Patient | 3 responses

Trying to find ways to decompress its crowded emergency department, the University of Chicago is "re-directing" non-urgent cases to community centers or clinics.

However, as emergency physician Shadowfax notes, you better be careful who you turn away, because as this case shows, doing it poorly results in a public relations nightmare.

Will those on Medicaid, or without insurance, be preferentially "re-directed" to safety net hospitals? In ...

How often do doctors ignore drug interaction warnings generated by electronic prescribing systems?

in Tech | no responses

It's surprisingly frequent.

WhiteCoat notes a study from the Archives of Internal Medicine looking at how often doctors overrode drug interaction warnings that pop up when prescribing.

I can say, at least with the EMR that I use, that it's quite frequent, with warnings occurring when refilling medications that patients have been taking safely for years.

I'm not alone with this experience, as ...

Medicare will not cover virtual colonoscopies, gastroenterologists breathe a sigh of relief

in Conditions | one response

CT, or "virtual", colonoscopy is an emerging imaging test designed to screen for colon cancer.

However, the data supporting its efficacy is not conclusive, and despite several studies performed by radiologists, its accuracy does not yet match that of a traditional, endoscopic colonoscopy.

Recently, the USPSTF reviewed the evidence, and could not recommend virtual colonoscopy as an acceptable method to screen for colon cancer.

Justifiably, MedPage ...

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